[Job stress and mental health at work].

In Japan, a study on mental health in workplace has expanded from tertiary to secondary and primary preventions of mental health disorders among employees. Recent movements suggest a trend of bringing numerous topics outside the industrial health, including those with perspectives from categories generally known as primordial prevention, such as enhancement of working life quality or improvement of work environment.First, according to the aforementioned trends, the present paper made an effort to organize the terms and concepts related to mental health disorders, which included the foundation for research and practice in this area as well as the outcomes of discussions on the tertiary and secondary preventions.Second, the primary models of work-related stress, along its impact on mental health, and the scales for assessing workers' mental health issues were discussed, which have been used in numerous studies since the 1990s. The introduction of those models and scales contributed immensely to the expansion of this field's research areas. However, a number of significant factors, most of which have social or cultural implications, can influence the connection between stress at workplace and health problems. Therefore, conducting large-scale study or systematic reviews targeting domestic cases exclusively is necessary to obtain evidence for establishing highly versatile measures against mental health problems in Japan.Third, in this regard, several noteworthy large-scale research projects in Japan are highlighted as a hope for encouraging such studies in this field. However, the occupational health practitioners' effort to understand the actual workplace situations where they attend to and to put the understanding into practice has been and will remain an indispensable attribute for them in the future.

Associations between work-related stressors and QALY in a general working population in Japan: a cross-sectional study.

OBJECTIVE: To investigate an association between quality-adjusted life years (QALY) and work-related stressors (job strain, effort/reward imbalance, and poor support from supervisor and coworkers), and estimate loss in QALY caused by these stressors. METHODS: A cross-sectional study investigated data from a third-wave survey (in December 2017) of a 2-year prospective cohort study of Japanese workers. At baseline (first-wave survey), 5000 participants were recruited from workers who registered with an internet survey company. A total of 2530 participants responded to the second-wave survey 1 year later. Participants were then further recruited to the third-wave survey. An online questionnaire collected information regarding health-related quality of life (measured by EQ-5D-5L), job strain, supervisor and coworker support (Brief Job Stress Questionnaire), effort/reward imbalance (Effort/reward Imbalance Questionnaire), and demographic variables (age, sex, education, occupation, work contract, smoking, and alcohol drinking). Multiple linear regression analysis of the QALY score calculated from responses to EQ-5D-5L was employed on standardized scores of the work-related stressors and adjusted for demographic variables (SPSS version 26). RESULTS: Data of 1986 participants were analyzed. Job strain (unstandardized coefficient, b = - 0.013, p < 0.01) and effort/reward imbalance (b = - 0.011, p < 0.01) and coworker support (b = 0017, p < 0.01) were significantly associated with QALY score in the fully adjusted model. CONCLUSION: Job strain, effort/reward imbalance, and poor coworker support may be associated with a reduced QALY score among workers. A substantial impairment in QALY associated with the work-related stressors indicates that workplace interventions targeting work-related stressors may be cost-effective.

Spouse Factors Related to the Leave Period of Employees on Temporary Leave for Depression.

In depression, the health condition of family members (particularly spouses) may influence the reinstatement process of employees on temporary leave. The length of leave from work may reflect the quality of the process leading to the stage of reinstatement, and a short period to reinstatement may increase the possibility of a smooth reinstatement. In this study we investigated the relationship between spouse factors and length of leave period. The subjects were 63 permanent employees on temporary leave for depression and their spouses. We investigated demographic characteristics, spouse factors, individual factors, household factors, and workplace factors, and extracted the factors related to the length of leave period through hierarchical multiple regression analysis. Results revealed that the Frenchay Activities Index (FAI), a spouse factor, was consistently and significantly related to the length of leave (ß = -0.37, P < 0.01). The higher the spouse FAI, the shorter the leave period of employees on temporary leave. In particular, the spouses' leisure activities were related to the leave period, whereas the effects of housework and work were unclear. The results suggest that the assessment and intervention of the spouses' activities of daily living are important in reinstatement support.

Work-Family Spillover, Job Demand, Job Control, and Workplace Social Support Affect the Mental Health of Home-Visit Nursing Staff.

The primary purpose of this study was to clarify the path by which high job demands on home-visit nursing staff affect their mental health through work-family negative spillover (WFNS, FWNS). The secondary purpose was to clarify the path by which high job control and high social support in the workplace positively affect the mental health of nursing home-visit staff through work-family positive spillover (WFPS, FWPS). A cross-sectional survey using a self-administered questionnaire was conducted on 1,022 visiting nursing staff working at 108 visiting nursing stations in Fukuoka Prefecture in February, 2019. The measurement tools comprised sociodemographic factors, the Japanese version of the Survey Work-Home Interaction - NijmeGen (SWING-J), Job Content Questionnaire (JCQ-22), the Work-Family Culture Scale, and the K6 scale. Six models were determined in an analysis of the model: (1) working time load → WFNS → FWNS → psychological distress, (2) job demands → WFNS → FWNS → psychological distress, (3) job demands → psychological distress, (4) workplace support → job control → WFPS → psychological distress, (5) workplace support → WFPS → psychological distress, and (6) workplace support → psychological distress. This study clarified that job demands and working time load may adversely affect the mental health of home-visit nursing staff through the mediation of WFNS. It was also clarified that high job control and workplace support may have a positive effect on mental health through the mediation of WFPS.

Social Support During Emergency Work and Subsequent Serious Psychological Distress: A Cross-Sectional Study Among Emergency Workers who Responded to the Fukushima Daiichi Nuclear Power Plant Accident.

OBJECTIVE: To examine the association between social support for emergency workers and levels of subsequent psychological distress, focusing on workers who responded to the Fukushima Nuclear Power Plant accident. METHODS: Male emergency workers (N = 1405) completed self-administered questionnaires, measuring social support during emergency work, subsequent serious psychological stress, occupational and demographic characteristics, and some confounders. Multiple logistic regression analyses were performed. RESULTS: Supervisor support was significantly associated with lower psychological distress, particularly for workers present at the site for over 31 days. For workers present for 10 days or less, coworker support was marginally significant. CONCLUSIONS: Social support is an important resource for reducing the risk of subsequent serious psychological distress among emergency workers. The associations of social support with psychological distress can differ depending on work duration and the providers of the support.

The effect of changes in overtime work hours on depressive symptoms among Japanese white-collar workers: A 2-year follow-up study.

OBJECTIVE: The purpose of this study was to investigate the effect of changes in overtime work hours on depressive symptoms among Japanese white-collar workers. METHODS: Participant data were collected from a company's annual mental health survey in June 2013 and June 2014. The participants comprised 922 workers who responded to the survey in both the years and had records of monthly working hours in the past 2 years. We obtained information on monthly working hours from personnel records from June 2012 to May 2014. Depressive symptoms were measured by the Brief Job Stress Questionnaire. Changes in overtime work hours were measured by creating a five-category variable for each monthly average of overtime work hours in the past year: (a) stable short, (b) decreased, (c) stable medium, (d) increased, and (e) stable long groups. Analysis of covariance was conducted to estimate the degree of depressive symptoms of each group for changes in overtime work hours. RESULTS: Significant differences among the groups were observed (F = 3.67, P = 0.006). In the Bonferroni multiple comparison test, significantly lower depressive symptoms were observed in the decreased group (point estimate = 9.56) compared to the stable short (10.76), stable medium (10.71), and increased groups (10.99). There was no significant difference between the decreased group and the stable long group (10.98). CONCLUSIONS: A decrease in overtime work hours may prevent the deterioration of mental health. This knowledge could support the necessity of mental health measures through decreasing overtime work hours proposed by national policy in Japan.

Effect of the National Stress Check Program on mental health among workers in Japan: A 1-year retrospective cohort study.

OBJECTIVES: This retrospective cohort study evaluated the impact of the Stress Check Program, a recently introduced national policy and program aimed at reducing psychological distress among Japanese workers. METHODS: A baseline survey was conducted from November 2015 to February 2016, the period when Japan began enforcing the Stress Check Program. A one-year follow-up survey was conducted in December 2016. In the follow-up survey, two exposure variables were collected: having taken the annual stress survey, and experiencing an improvement in the psychosocial work environment. Psychological distress was assessed using the Brief Job Stress Questionnaire (BJSQ) at baseline and 1-year follow-up. The two exposure variables were used to define four groups: "Neither", "Stress survey (SS) only", "Psychosocial work environment improvement (WI) only", and "Both". BJSQ results were analyzed using repeated measures general linear modeling (GLM). RESULTS: The study included 2,492 participants: 1,342 in the "Neither" group, 1,009 in the "SS only" group, 76 in the "WI only" group, and 65 in the "Both" group. Overall time-group interaction effects were not significant. The "Both" group showed significantly greater improvements in psychological distress than the "Neither" group (p = 0.02) at the 1-year follow-up, although the effect size was small (d = -0.14). CONCLUSIONS: Combination of the annual stress survey and improvement in psychosocial work environment may have been effective in reducing psychological distress in workers, although the effect size was small.

Pokémon GO and psychological distress, physical complaints, and work performance among adult workers: a retrospective cohort study.

The effects of Pokémon GO, a new mobile game application which utilizes augmented reality, on risky behavior and health have already been discussed in anecdotal evidence. However, there have been no studies about its effects on mental health. This study investigated the relationships between Pokémon GO and psychological distress from an existing workers' cohort in Japan. Online surveys were conducted to 3,915 full-time workers, at baseline (Nov 26, 2015-Feb 18, 2016) and at follow-up (Dec 1-4, 2016), using a self-report questionnaire. Pokémon GO players were defined as participants who had played Pokémon GO for one month or longer. Psychological distress was measured using validated scales. Of the completers, 246 (9.7%) had continued to play Pokémon GO. They were significantly younger than non-players. From the results of the general linear modeling, improvement in psychological distress was significantly greater among Pokémon GO players than among non-players (p = 0.025). Cohen's d for the difference in psychological distress was -0.20 (95% CI, -0.33, -0.07). Pokémon GO may be effective for improving psychological distress among workers. Although its effect size is small, the game could have positive effects on the mental health of the adult working population.

Recovery of Percent Vital Capacity by Breathing Training in Patients With Panic Disorder and Impaired Diaphragmatic Breathing.

Slow diaphragmatic breathing is one of the therapeutic methods used in behavioral therapy for panic disorder. In practice, we have noticed that some of these patients could not perform diaphragmatic breathing and their percent vital capacity was initially reduced but could be recovered through breathing training. We conducted a comparative study with healthy controls to investigate the relationship between diaphragmatic breathing ability and percent vital capacity in patients with panic disorder. Our findings suggest that percent vital capacity in patients with impaired diaphragmatic breathing was significantly reduced compared with those with normal diaphragmatic breathing and that diaphragmatic breathing could be restored by breathing training. Percent vital capacity of the healthy controls was equivalent to that of the patients who had completed breathing training. This article provides preliminary findings regarding reduced vital capacity in relation to abnormal respiratory movements found in patients with panic disorder, potentially offering alternative perspectives for verifying the significance of breathing training for panic disorder.

Changes in drinking habits and psychological distress in Japanese non- or occasional drinking workers: a one-year prospective cohort study.

This study investigated whether non- or occasional drinkers' changes in drinking habits during a one-year period were related to psychological distress. Overall, 2,495 non- or occasional drinking employees (2,109 men and 386 women) completed a self-administered questionnaire measuring alcohol intake, psychological distress (12-item General Health Questionnaire), and demographic characteristics at baseline and one-year follow-up. They also completed a Web-based version of the Brief Job Stress Questionnaire to assess job stressors at baseline. Participants were categorized into three groups (stable non- or occasional drinkers; new light drinkers; new moderate drinkers) according to weekly alcohol consumption at follow-up (males 0 g/wk, 1-79 g/wk, and ≥80 g/wk; females 0 g/wk, 1-39 g/wk, and ≥40 g/wk, respectively); multiple logistic regression analyses were conducted by sex. Among only male participants, both stable non- or occasional drinkers and new moderate drinkers showed significantly higher odds ratios for psychological distress at follow-up than new light drinkers after adjusting for demographic characteristics, job stressors, and psychological distress at baseline (adjusted odds ratios of 1.72 and 1.99, respectively). These findings suggest that men who started to drink 80 g or more alcohol per week during the one-year follow-up period should have been monitored for psychological distress.

Changes in the psychosocial work characteristics and insulin resistance among Japanese male workers: a three-year follow-up study.

OBJECTIVE: This study investigated the impact of changes in psychosocial work characteristics on insulin resistance (IR) among Japanese male workers. METHODS: Subjects were 1,815 male workers who received a comprehensive health examination and requested measurement of their serum insulin level in Fiscal Years (FY) 2008 and 2011. Psychosocial work characteristics, including job demands, job control, and workplace social support (from supervisors and coworkers), were assessed in each of the job demands-control and demand-control-support models. Psychosocial work characteristics were assessed by the Brief Job Stress Questionnaire. Changes in the psychosocial work characteristics were measured by creating a four-category variable for each of the psychosocial work characteristics: (1) stable low group, (2) increased group, (3) decreased group, and (4) stable high group. We defined IR as a value of 2.5 or more on the homeostasis model assessment of insulin resistance (HOMA-IR), or having a diagnosis of diabetes. A series of multiple logistic regression analyses were conducted. RESULTS: The group experiencing a decrease in supervisor support had a significantly higher risk of having IR compared to the stable high group with an odds ratio (OR) of 2.44; 95% CI: 1.48-4.02. After adjusting for covariates, this significant association was unchanged; the OR was 2.19; 95% CI: 1.23-3.91. On the other hand, there was no significant association of changes in the psychosocial work characteristics, expect for decrease in supervisor support, with IR. CONCLUSIONS: A decrease in supervisor support was found to be an independent risk factor for worsening IR.

[Problems in Providing Care to Young Workers with Mental Health Disturbance - A Survey Using of the Cases of Workers Who Had Taken Sick Leave Due to Mental Health Disturbance].

In this study we discuss the measures of providing care to young workers with mental health disturbance by analyzing the cases of workers who had taken sick leave due to mental health disturbance. We analyzed 36 cases, collected from 11 occupational physicians, of workers who had taken sick leave due to mental health disturbance, and discuss measures for providing care to such young workers. We organized and classified data containing the details of the care provided to the workers and analyzed the main aspects and problems in providing it. We compared two age groups of workers: a below age 30 group, and an age 30 and above group. We observed that occupational nurses were more frequently the primary persons who dealt with workplace consultations in the below age 30 group (before sick leave: 38.9%; during sick leave: 38.9%) compared to the age 30 and above group (before sick leave: 16.7%, during sick leave: 11.1%). Most of the case providers expressed the opinion that a support system is necessary to help the workers return to work and it is an important factor in providing care to workers who have taken sick leave due to mental health disturbance. Coordination with the families of the workers was also important in the below age 30 group. It might be difficult to assign young workers to suitable workplaces or duties because of their inadequate job skills, lack of sufficient experience, and influence of personal factors on mental health. Our results suggest that it is important to provide appropriate care for young workers with mental health disturbance, such as support by occupational nurses, and to strengthen the collaboration between their families and the workplace staff.

Change in organizational justice and job performance in Japanese employees: A prospective cohort study.

OBJECTIVE: The aim of the present study was to investigate the association of one-year change in organizational justice (i.e., procedural justice and interactional justice) with job performance in Japanese employees. METHODS: This study surveyed 425 men and 683 women from a manufacturing company in Japan. Self-administered questionnaires, including the Organizational Justice Questionnaire (OJQ), the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) and the scales on demographic characteristics, were administered at baseline (August 2009). At one-year follow-up (August 2010), the OJQ and WHO-HPQ were used again to assess organizational justice and job performance. The change in organizational justice was measured by dichotomizing each OJQ subscale score by median at baseline and follow-up, and the participants were classified into four groups (i.e., stable low, adverse change, favorable change and stable high). Analysis of covariance (ANCOVA) was employed. RESULTS: After adjusting for demographic and occupational characteristics and job performance at baseline, the groups classified based on the change in procedural justice differed significantly in job performance at follow-up (ANCOVA: F [3, 1097]=4.35, p<0.01). Multiple comparisons revealed that the stable high procedural justice group had significantly higher job performance at follow-up compared with the stable low procedural justice group. The groups classified based on change in interactional justice did not differ significantly in job performance at follow-up (p>0.05). CONCLUSIONS: The present findings suggest that keeping the level of procedural justice high predicts higher levels of job performance, whereas the psychosocial factor of interactional justice is not so important for predicting job performance.

Buffering effects of job resources on the association of overtime work hours with psychological distress in Japanese white-collar workers.

PURPOSE: The purpose of the present study was to investigate the buffering effects of job resources, utilizing the job demands-control (or demand-control-support) and effort-reward imbalance models (i.e., job control, workplace social support, and extrinsic reward), on the association of overtime work hours with psychological distress in Japanese employees. METHODS: A total of 1,198 participants (valid response rate = 93.7 %) from five branches of a manufacturing company in Japan completed a self-administered questionnaire comprising the scales assessing job resources, psychological distress, and demographic characteristics. We obtained the information on working hours in the most recent month from the personnel records of the surveyed company. Multiple logistic regression analyses were conducted. In a series of analyses, interaction term of overtime work hours with each job resource was included in the model. RESULTS: Significant interaction effect of overtime work hours with job control was observed. Among the low job control group, the long overtime (80 h or more) subgroup had a significantly higher prevalence odds ratio of psychological distress compared to the short overtime (44 h or less) subgroup. No significant association of overtime work hours with psychological distress was found among the high job control group. On the other hand, there was no significant interaction effect of overtime work hours with workplace social support or extrinsic reward. CONCLUSIONS: The present findings suggest that high job control has an effect on reducing psychological distress in relation to overtime work hours in Japanese employees.

Brief intervention in the workplace for heavy drinkers: a randomized clinical trial in Japan.

AIMS: To investigate the effectiveness of brief intervention (BI) conducted in the workplace for heavy drinkers. METHODS: A randomized controlled trial was conducted at six companies in Japan. Participants were heavy drinkers who met the inclusion criteria and were randomized into three groups: the BI group, BI with diary group and a control group. Outcomes (total drinks, binge drinking episodes and alcohol-free days) were evaluated at 3 and 12 months. RESULTS: The 304 participants recruited were allocated to the three groups and 277 participated in all follow-up evaluations. Dropout rates in the respective groups were 7.0, 14.9 and 5.5%. Some improvements were observed in all the groups. In particular, alcohol-free days in the BI group were significantly increased by 93.0% at 12 months. Total drinks at 12 months were reduced by 41 g per week in the BI group compared with the control group, although the intergroup difference was not significant. CONCLUSION: BI in the workplace is effective for increasing the number of alcohol-free days. However, the effectiveness on decreasing alcohol consumption was unclear, which could be explained by alcohol screening itself causing a reduction in drinking.

Job demands, job resources, and job performance in japanese workers: a cross-sectional study.

This study investigated the cross-sectional association of job demands (i.e., psychological demands) and job resources (i.e., decision latitude, supervisor support, co-worker support, and extrinsic reward) with job performance. A total of 1,198 workers (458 males and 740 females) from a manufacturing company in Japan completed a self-administered questionnaire that included the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, World Health Organization Health and Work Performance Questionnaire, and demographic survey. Hierarchical multiple regression analyses were conducted. After adjusting for demographic characteristics, decision latitude (ß=0.107, p=0.001) and extrinsic reward (ß=0.158, p<0.001) were positively and significantly associated with job performance while supervisor support (ß=-0.102, p=0.002) was negatively and significantly associated with job performance. On the other hand, psychological demands or co-worker support was not significantly associated with job performance. These findings suggest that higher decision latitude and extrinsic reward enhance job performance among Japanese employees.

[Characteristics of mental health problems among Japanese young workers and their measures--a cross-sectional survey using an open-ended questionnaire].

OBJECTIVES: The purpose of this study is to investigate the characteristics of mental health problems faced by young workers and the effectiveness of measures implemented for improving their mental health. METHOD: We sent anonymous open-ended questionnaires to 386 occupational physicians in Japan, and received questionnaire responses from 109 of them. The questionnaire was comprised of two parts. The first part addressed the age-specific characteristics of workers with mental health problems. The second part focused on the mental health measures implemented for young workers and opinions on their effectiveness. The responses were entered in a database. Frequently appearing words were identified and the number of times of the appearance was counted for each question. We conducted statistical analysis to examine the association between word frequency and age group in the first part. Ten investigators and collaborators of this study arranged the descriptions of the mental health measures for young workers and the opinions on their effectiveness in the second part. RESULTS: For mentally ill subjects in their 20s, we identified a range of frequently occurring words using correspondence analysis. The frequently occurring words were: "personality", "immaturity", "extrapunitive", "developmental disorder", "schizophrenia," "new-type depression", "maladjustment", "entering a company", "society", "superior," and "co-worker", Work-related words, such as "qualitative workloads" and "quantitative workloads", were identified for those in their 30s, and greater numbers of words on life outside of the workplace, such as "home," "child" and "nursing care" were identified for those in their 40s. Among the responses about the types of measures implemented for young workers, education and interviews were most common, and most respondents indicated that the effectiveness of these measures was unknown. A few respondents indicated that coordination between young workers' families and the persons concerned in the workplace, such as their superiors, personnel management staff, and occupational physicians, was useful to encourage their family to provide support. CONCLUSIONS: Our findings suggest that mental health problems among young workers are multilaterally affected by personal factors, such as personal maladjustment to their work and, immature or extrapunitive character, mental disorder, or job stressors in the background and in their workplace organization. Strengthening the coordination among young workers' families and the persons concerned in the workplace may be an effective mental health measure for young workers.

Effect modification by coping strategies on the association of organizational justice with psychological distress in Japanese workers.

OBJECTIVES: Several previous studies showed that the lack of organizational justice was associated with poor mental health. However, no study examined the effect modification by internal factor, such as coping strategies, on the association of organizational justice with mental health. The purpose of the present study was to investigate the effect modification by coping strategies on the association of organizational justice with psychological distress. METHODS: A total of 471 men and 764 women from a manufacturing company in Japan completed self-administered questionnaires, including the Organizational Justice Questionnaire, K6 scale (i.e., psychological distress scale), Brief Scales for Coping Profile, and demographic characteristics. Multiple logistic regression analyses were conducted for each coping strategy. RESULTS: After adjusting for demographic characteristics, the association of the lack of procedural justice with psychological distress was greater among the low changing a point of view group than among their counterparts. Furthermore, the interaction term of procedural justice with changing a point of view was significant. The association of the lack of procedural justice and interactional justice with psychological distress was also greater among the high emotional expression involving others group than among their counterparts, while the interaction terms of procedural justice and interactional justice with emotional expression involving others were marginally significant. CONCLUSIONS: Positive emotion-focused coping strategies, such as changing a point of view, may effectively prevent psychological distress when there is a lack of organizational justice, while problem-focused coping strategies may have no effects, and negative emotion-focused coping strategies, such as emotional expression involving others, may have harmful effects on the association.

[Role of occupational physician for workers' mental health].

In this paper, I briefly review the history of occupational mental health as well as administrative trends in Japan, and summarized how occupational physicians should get involved in these activities. As for mental health in the workplace, occupational physicians are required to participate in a large number of wide-ranging activities, including the management of mental illness. On the other hand, approving the occupational physician who is in charge of mental health affairs only has some important ramifications which cannot be disregarded. Careful consideration should be given to this matter.

[Occupational health and early detection of depression].

The Ministry of Health, Labor and Welfare is planning to conduct a stress check for employees, using the opportunity of the periodical health check. In this paper, the author summarizes some problems with the plan, and refers to the meaning of detecting mental disorders in the workplace. Just like psychiatric treatment and other mental health activities, occupational mental health should be discussed from the historical point of view, excluding shortsighted judgment and improvised measures.